HomeMy WebLinkAboutInsurance Certificate: Mountain View Paving Inc.ACCORD® CERTIFICATE OF LIABILITY INSURANCE
DATE (MMI DIY )
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement{s).
PRODUCER
PO
HUB International Northwest, LLCFAXPHONE Eugene OR 97440
CONTACT
_NAME: ...._Kim SChnetzkY..-------------_----_----------__......__..._...,___..._-...._..__.__..._.
_ tJo E_x__t�: 541 fi87 1117 (� �� 541-342-828Q
ADDRESS: kim.schnetzky@hubinternational.com
INSURER�SJ AFFORDING COVERAGE NAIC #
INSURER A: Cincinnati Casualty 28665
.__
INSURED 14229
INSURER B
Mountain View Paving Inc
PO BOX 508
INSURERC:
_..-
INSURERD:
Talent OR 97540
INSURER E
INSURER F :''
COVERAGES CERTIFICATE NUMBER:910785161 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED
BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL'',SUBR''�' POLICY NUMBER
LTR
MOLIC EFF 1 MMIDDIYYYY ���.�.-..�.........._.�..-_.._.. LIMITS
A X COMMERCIAL GENERAL LIABILITY . ', Y 1 EPP0404007
9/25/2024 '',, 9/25/2025 EACH OCCURRENCE
CLAIMS -MADE ': X OCCUR
OAMA fT6RNTE�
'j' PREM35=S Ea occurrence 5 500,000
_ �I
MED EXP ();ny one person) —1 S 10,000 --- ---
I~
PERSONAL & ADV INJURY ', 5 1.000.000
i GEN'L AGGREGATE LIMIT APPLIES PER: '',
G£NERALAGGREGAT£;i 5 2.D00.000
POLICY ; X '', PRO- a LOC
' JECT a
PRODUCTS- GOPAPIOP AGG $2.000 000
I OTHER:
A I AUTOMOBILE LIABILITY ''. Y
Y 'I EPP 0404007
�
912512C)24 9/25/2025 COMBINED SINGLE LIMIT S 1.000,000
�L.tIE? acddenti.._..........�._.._..._...__T
X ANY AUTO
l
i BODILY INJURY (Per person) 5
OWNED ;..ISCHEDULED
AUTOS ONLY. AUTOS
7_—
BODILY INJURY {Per accident)
XI HIRED I X NON -OWNED
i !
PROPERTY DAMAGE
AUTOS ONLY .W._I, AUTOS ONLY
i
Per accident
i
i
5
A X 11 UMBRELLA LIAR XJ OCCUR
� EPP 0404007 I
912512024 � 912512025 :EACH OCCURRENCEI S 1,000,000
EXCESS i.lA6 CLAIMS-MADEI
i j
.._ . .............
AGGREGATE_ _ 51,000,000
-- - — - - ---------------- --- --- -...
DED RETENTIONS
''� 5
i WORKERS COMPENSATION
I PER OTH-
` STA�UTE_,___� R__
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETORIPARTNERIEXECUTNE 1^
OFFICERIMEMBEREXCLUDED? ' I
N 1 A
i
E.L. EACH ACCIDENT S
--------------- --
{Mandatory in Ni
1f yes, describe under
I
i
E.L. DISEASE - EA EMPLOYEE'. S
------------'--""-----'"mm-_
DESCRIPTION OF OPERATIONS below''
E.L. DISEASE -POLICY LIMIT 5
A ;Scheduled Equipment
EPP 0404007''
912512024 912512025 'Limit: See Eelow Ded: S1,000
All Risk Intl Flood
'..
Leased 8 Rented Equip-
{
Limit: 5100.000 Ded: S5D0
DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES ACORD 101, Additional Remarks Schedule, maybe attached it more space is required)
Certificate holder and all entities required by written contract are included as additional insureds on a primary and non-contributory basis with waiver of
subrogation as respects to the general liability including completed operations and auto
liability, including waiver of subrogation as required by written contract
per attached endorsements. Subject to policy limits. terms, conditions, and exclusions.
City of Ashland
90 N Mountain
Ashland OR 97520
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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